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WO2016066879A1 - Dispositif de localisation d'arrythmies cardiaques - Google Patents

Dispositif de localisation d'arrythmies cardiaques Download PDF

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Publication number
WO2016066879A1
WO2016066879A1 PCT/ES2015/070779 ES2015070779W WO2016066879A1 WO 2016066879 A1 WO2016066879 A1 WO 2016066879A1 ES 2015070779 W ES2015070779 W ES 2015070779W WO 2016066879 A1 WO2016066879 A1 WO 2016066879A1
Authority
WO
WIPO (PCT)
Prior art keywords
intracavitary
locating
cardiac arrhythmias
electrodes
dimensional reconstruction
Prior art date
Legal status (The legal status is an assumption and is not a legal conclusion. Google has not performed a legal analysis and makes no representation as to the accuracy of the status listed.)
Ceased
Application number
PCT/ES2015/070779
Other languages
English (en)
Spanish (es)
Inventor
Andreu MARTÍNEZ CLIMENT
Felipe ATIENZA FERNÁNDEZ
Ángel ARENAL
Francisco FERNÁNDEZ AVILÉS
María S. GUILLEM SÁNCHEZ
Current Assignee (The listed assignees may be inaccurate. Google has not performed a legal analysis and makes no representation or warranty as to the accuracy of the list.)
Universidad Politecnica de Valencia
Fundacion para la Investigacion Biomedica del Hospital Gregorio Marañon
Original Assignee
Universidad Politecnica de Valencia
Fundacion para la Investigacion Biomedica del Hospital Gregorio Marañon
Priority date (The priority date is an assumption and is not a legal conclusion. Google has not performed a legal analysis and makes no representation as to the accuracy of the date listed.)
Filing date
Publication date
Application filed by Universidad Politecnica de Valencia, Fundacion para la Investigacion Biomedica del Hospital Gregorio Marañon filed Critical Universidad Politecnica de Valencia
Priority to EP15855226.5A priority Critical patent/EP3213680B1/fr
Priority to ES15855226T priority patent/ES2969995T3/es
Priority to US15/522,590 priority patent/US11672463B2/en
Publication of WO2016066879A1 publication Critical patent/WO2016066879A1/fr
Anticipated expiration legal-status Critical
Ceased legal-status Critical Current

Links

Classifications

    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B5/00—Measuring for diagnostic purposes; Identification of persons
    • A61B5/24—Detecting, measuring or recording bioelectric or biomagnetic signals of the body or parts thereof
    • A61B5/316—Modalities, i.e. specific diagnostic methods
    • A61B5/318—Heart-related electrical modalities, e.g. electrocardiography [ECG]
    • A61B5/346—Analysis of electrocardiograms
    • A61B5/349—Detecting specific parameters of the electrocardiograph cycle
    • A61B5/361—Detecting fibrillation
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B5/00—Measuring for diagnostic purposes; Identification of persons
    • A61B5/0033—Features or image-related aspects of imaging apparatus, e.g. for MRI, optical tomography or impedance tomography apparatus; Arrangements of imaging apparatus in a room
    • A61B5/004—Features or image-related aspects of imaging apparatus, e.g. for MRI, optical tomography or impedance tomography apparatus; Arrangements of imaging apparatus in a room adapted for image acquisition of a particular organ or body part
    • A61B5/0044—Features or image-related aspects of imaging apparatus, e.g. for MRI, optical tomography or impedance tomography apparatus; Arrangements of imaging apparatus in a room adapted for image acquisition of a particular organ or body part for the heart
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B5/00—Measuring for diagnostic purposes; Identification of persons
    • A61B5/0033—Features or image-related aspects of imaging apparatus, e.g. for MRI, optical tomography or impedance tomography apparatus; Arrangements of imaging apparatus in a room
    • A61B5/0035—Features or image-related aspects of imaging apparatus, e.g. for MRI, optical tomography or impedance tomography apparatus; Arrangements of imaging apparatus in a room adapted for acquisition of images from more than one imaging mode, e.g. combining MRI and optical tomography
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B5/00—Measuring for diagnostic purposes; Identification of persons
    • A61B5/24—Detecting, measuring or recording bioelectric or biomagnetic signals of the body or parts thereof
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B5/00—Measuring for diagnostic purposes; Identification of persons
    • A61B5/24—Detecting, measuring or recording bioelectric or biomagnetic signals of the body or parts thereof
    • A61B5/25—Bioelectric electrodes therefor
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B5/00—Measuring for diagnostic purposes; Identification of persons
    • A61B5/24—Detecting, measuring or recording bioelectric or biomagnetic signals of the body or parts thereof
    • A61B5/25—Bioelectric electrodes therefor
    • A61B5/279—Bioelectric electrodes therefor specially adapted for particular uses
    • A61B5/28—Bioelectric electrodes therefor specially adapted for particular uses for electrocardiography [ECG]
    • A61B5/282—Holders for multiple electrodes
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B5/00—Measuring for diagnostic purposes; Identification of persons
    • A61B5/24—Detecting, measuring or recording bioelectric or biomagnetic signals of the body or parts thereof
    • A61B5/316—Modalities, i.e. specific diagnostic methods
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B5/00—Measuring for diagnostic purposes; Identification of persons
    • A61B5/24—Detecting, measuring or recording bioelectric or biomagnetic signals of the body or parts thereof
    • A61B5/316—Modalities, i.e. specific diagnostic methods
    • A61B5/318—Heart-related electrical modalities, e.g. electrocardiography [ECG]
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B5/00—Measuring for diagnostic purposes; Identification of persons
    • A61B5/72—Signal processing specially adapted for physiological signals or for diagnostic purposes
    • A61B5/7271—Specific aspects of physiological measurement analysis
    • A61B5/7278—Artificial waveform generation or derivation, e.g. synthesizing signals from measured signals
    • G—PHYSICS
    • G06—COMPUTING OR CALCULATING; COUNTING
    • G06T—IMAGE DATA PROCESSING OR GENERATION, IN GENERAL
    • G06T17/00—Three dimensional [3D] modelling, e.g. data description of 3D objects
    • G—PHYSICS
    • G16—INFORMATION AND COMMUNICATION TECHNOLOGY [ICT] SPECIALLY ADAPTED FOR SPECIFIC APPLICATION FIELDS
    • G16H—HEALTHCARE INFORMATICS, i.e. INFORMATION AND COMMUNICATION TECHNOLOGY [ICT] SPECIALLY ADAPTED FOR THE HANDLING OR PROCESSING OF MEDICAL OR HEALTHCARE DATA
    • G16H50/00—ICT specially adapted for medical diagnosis, medical simulation or medical data mining; ICT specially adapted for detecting, monitoring or modelling epidemics or pandemics
    • G16H50/50—ICT specially adapted for medical diagnosis, medical simulation or medical data mining; ICT specially adapted for detecting, monitoring or modelling epidemics or pandemics for simulation or modelling of medical disorders
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B18/00—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body
    • A61B18/04—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body by heating
    • A61B18/12—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body by heating by passing a current through the tissue to be heated, e.g. high-frequency current
    • A61B18/14—Probes or electrodes therefor
    • A61B18/1492—Probes or electrodes therefor having a flexible, catheter-like structure, e.g. for heart ablation
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B2576/00—Medical imaging apparatus involving image processing or analysis
    • A61B2576/02—Medical imaging apparatus involving image processing or analysis specially adapted for a particular organ or body part
    • A61B2576/023—Medical imaging apparatus involving image processing or analysis specially adapted for a particular organ or body part for the heart
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B5/00—Measuring for diagnostic purposes; Identification of persons
    • A61B5/24—Detecting, measuring or recording bioelectric or biomagnetic signals of the body or parts thereof
    • A61B5/25—Bioelectric electrodes therefor
    • A61B5/279—Bioelectric electrodes therefor specially adapted for particular uses
    • A61B5/28—Bioelectric electrodes therefor specially adapted for particular uses for electrocardiography [ECG]
    • A61B5/283—Invasive
    • A61B5/287—Holders for multiple electrodes, e.g. electrode catheters for electrophysiological study [EPS]

Definitions

  • the present invention discloses a device for locating cardiac arrhythmias and, in particular, the location and detection of the cardiac regions responsible for arrhythmias with patterns that are not necessarily stochastic, such as atrial fibrillation.
  • Cardiac arrhythmias are the leading cause of death in Europe.
  • the treatment by ablation of said arrhythmias is performed by electrical isolation of the cardiac region causing the onset and / or maintenance of each arrhythmia. That is why the key to properly treat these arrhythmias lies in the detection of the target cardiac region of the ablation process.
  • said detection is performed by catheterization processes in which, in an invasive way, cardiac activity is mapped sequentially and, in case the arrhythmia presents a stable pattern, locate the target region of the ablation.
  • the construction of a patient's torso model is required from computed tomography or magnetic resonance imaging prior to the procedure, which It increases the cost of it and hinders its clinical implementation.
  • the equipment used in these procedures have important limitations in the ability to accurately reconstruct cardiac activity from the signals recorded in the torso during irregular arrhythmias with multiple wave fronts such as atrial fibrillation.
  • the maps of reconstructed epicardial potentials through the use of quadratic stabilization functions show a paradoxically simple electrical activity that contrasts with the complexity observed in both the electrograms recorded invasively [Konings KTS,, et al. High-density mapping of electrically-induced atrialfibrillation in humans.
  • the present invention discloses a device that solves the problems of the prior art in that it incorporates more real-time information that allows to more accurately locate the cardiac region responsible for the onset and / or maintenance of cardiac arrhythmias. irregular.
  • the present invention makes it possible to characterize the cardiac electrophysiological behavior by means of the combined analysis of the global information obtained by means of cartography and, optionally, intracavitary information obtained by means of catheters. Consequently, the applied method can be implemented non-invasively or, alternatively, by a smaller invasion in the patient than the known methods and devices and that It would help increase the accuracy of the data obtained.
  • a cardiac arrhythmia localization device comprising a three-dimensional reconstruction of a patient's torso and a series of surface electrodes comprising:
  • three-dimensional reconstruction means that generate the three-dimensional reconstruction of the patient's torso through a series of images obtained by at least one camera;
  • data processing means that generate, by means of three-dimensional reconstruction and electrode position, an electrocardiographic surface map
  • said electrocardiographic surface map comprising a series of data corresponding to electrode readings related to areas of the three-dimensional reconstruction.
  • the surface electrode locating means detect the position of the electrodes by processing the images obtained by the at least one camera.
  • the present invention contemplates, by way of example that said cameras may be visible image cameras and / or angiography cameras.
  • said cameras may be visible image cameras and / or angiography cameras.
  • the surface electrocardiographic map comprises means for detecting the area of the torso that presents a cardiac arrhythmia. This is done by processing the signals coming from the surface electrodes and correlating these signals with the areas of the body in which each electrode is arranged. In this way it can be known to which electrode a arrhythmia signal corresponds and, consequently, the area in which it occurs.
  • the present invention has at least one intracavitary catheter. The arrangement of this intracavitary catheter provides a greater amount of data to the device that allows greater accuracy on the area presenting the arrhythmia.
  • intracavitary anatomical reconstruction that is, having a three-dimensional representation with the dimensions of the heart and of each of its cavities as well as the electrical signals corresponding to each of said cavities (signals from the external electrodes as well as the intracavitary electrodes). This is obtained by solving what, in the following, will be called the inverse problem and that is solved by combining quadratic and non-quadratic stabilization functions under conditions of discontinuity.
  • the processing means by means of the intracavitary anatomical reconstruction and the electrocardiographic surface map, can generate an electroanatomic map in which the electrical activity of each zone is identified and, also, contemplate that, from said electroanatomic map means for detecting cardiac arrhythmias may be provided.
  • Figure 1. Shows a schematic view of the device for detecting cardiac arrhythmias according to the present invention, as well as its detection method.
  • FIG. 1 A preferred embodiment of the present invention is seen in Figure 1.
  • this device contemplates the realization, essentially, of three measurements.
  • a first measurement is the realization, by means of a set of images (1) of a three-dimensional reconstruction (4) of the patient's torso, for example, two-dimensional images obtained by means of a camera.
  • This reconstruction is performed by at least two photographs by image processing techniques widely known in the prior art.
  • a second measurement is an electrocardiographic surface map.
  • This map is made by taking data from a series of surface electrodes (2) and associating the data collection of said electrodes with a particular area of the patient's body.
  • the data obtained by means of said electrodes is a series of electrical signals (5) taken non-invasively (without performing any surgical procedure). Additionally, as mentioned above, it is important to find a correlation between the electrical signals (5) and the position of the electrode that each of the signals has taken in order to determine to which part of the heart each signal corresponds.
  • the present invention contemplates means for detecting the position of the electrodes.
  • This detection of the position of the electrodes is carried out, especially preferably, by means of the analysis of images, in particular, by means of the analysis of the images (1) by means of which the three-dimensional reconstruction (4) of the patient's torso is performed or , alternatively, of other images obtained by means of the same means of obtaining images.
  • intracavitary records (3) can be made by using at least one catheter. Although this procedure is intrusive, it requires less intrusiveness than prior art mapping procedures.
  • an intracavitary anatomical reconstruction (6) can be obtained which can be used for epicardial reconstruction (i.e. an intracavitary anatomical reconstruction) a from non-invasive records by using a regularization of the inverse problem resolution (8) based on quadratic and non-quadratic stabilization functions under conditions of spatio-temporal discontinuity. In this way the signals calculated from the non-invasive registers are used for the representation of the epicardial electroanatomic maps (11).
  • intracavitary mapping (3) is not essential for the system to calculate epicardial potentials, which are calculated from non-invasive surface records by solving the inverse problem, but using a few intracavitary points. It helps a lot to a reliable reconstruction of the mathematical problem and thus ensure its reliability even during irregular arrhythmias such as atrial fibrillation.
  • an intracavitary anatomical reconstruction (6) can be obtained which can be used for epicardial reconstruction from non-invasive registers by using a regularization of the resolution of the Inverse problem based on quadratic and non-quadratic stabilization functions under conditions of spatio-temporal discontinuity, that is, an electroanatomic correlation is performed (8) taking into account the data obtained by the electrocardiographic surface map (7) and intracavitary anatomical reconstruction (6) .
  • the resolution of the inverse problem is carried out by iterative estimation of the transfer matrix between the potentials in the atrial epicardium (U A ) and the potentials in the torso (U T ):
  • the intracavitary electrical signals (10) obtained by the intracavitary catheter can be taken as an anchor and validation point for the reconstruction of the entire epicardial map from the non-invasive signals in order to perform a Stabilization (9) of the inverse problem through the spatio-temporal correlation of the intracavitary registration points based on the information in time, phase, module, spectrum and causality. In this way the activity of the entire atrium is reconstructed quickly and reliably, even during irregular arrhythmias such as atrial fibrillation.

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  • Health & Medical Sciences (AREA)
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  • Public Health (AREA)
  • Medical Informatics (AREA)
  • Biomedical Technology (AREA)
  • General Health & Medical Sciences (AREA)
  • Pathology (AREA)
  • Animal Behavior & Ethology (AREA)
  • Heart & Thoracic Surgery (AREA)
  • Molecular Biology (AREA)
  • Surgery (AREA)
  • Biophysics (AREA)
  • Veterinary Medicine (AREA)
  • Cardiology (AREA)
  • Nuclear Medicine, Radiotherapy & Molecular Imaging (AREA)
  • Radiology & Medical Imaging (AREA)
  • Computer Vision & Pattern Recognition (AREA)
  • Software Systems (AREA)
  • Physiology (AREA)
  • Psychiatry (AREA)
  • Signal Processing (AREA)
  • Computer Graphics (AREA)
  • Geometry (AREA)
  • Artificial Intelligence (AREA)
  • General Physics & Mathematics (AREA)
  • Theoretical Computer Science (AREA)
  • Data Mining & Analysis (AREA)
  • Databases & Information Systems (AREA)
  • Epidemiology (AREA)
  • Primary Health Care (AREA)
  • Measurement And Recording Of Electrical Phenomena And Electrical Characteristics Of The Living Body (AREA)
  • Nuclear Medicine (AREA)

Abstract

Le dispositif de localisation d'arrythmies cardiaques comprend une reconstruction tridimensionnelle (4) du torse d'un pacient et une série d'électrodes de surface (2), la reconstruction tridimensionnelle (4) du torse du patient étant générée par l'intermédiaire d'une série d'images (1) obtenues au moyen d'au moins une caméra. En particulier, le dispositif comprend des moyens de localisation des électrodes de surface (2) qui détectent la position des électrodes par rapport au torse du patient et des moyens de traitement des données qui génèrent, au moyen de la reconstruction tridimensionnelle (4) et de la position des électrodes, une carte électrocardiographique de surface (7) et ladite carte électrocardiographique de surface (7) présente une série de données correspondant aux lectures des électrodes de surface (2) reliées à des zones de la reconstruction tridimensionnelle (4).
PCT/ES2015/070779 2014-10-30 2015-10-29 Dispositif de localisation d'arrythmies cardiaques Ceased WO2016066879A1 (fr)

Priority Applications (3)

Application Number Priority Date Filing Date Title
EP15855226.5A EP3213680B1 (fr) 2014-10-30 2015-10-29 Dispositif de localisation d'arrythmies cardiaques
ES15855226T ES2969995T3 (es) 2014-10-30 2015-10-29 Dispositivo de localización de arritmias cardiacas
US15/522,590 US11672463B2 (en) 2014-10-30 2015-10-29 Device for identifying the site of cardiac arrhythmias

Applications Claiming Priority (2)

Application Number Priority Date Filing Date Title
ESP201431597 2014-10-30
ES201431597A ES2572142B1 (es) 2014-10-30 2014-10-30 Dispositivo de localización de arritmias cardiacas

Publications (1)

Publication Number Publication Date
WO2016066879A1 true WO2016066879A1 (fr) 2016-05-06

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PCT/ES2015/070779 Ceased WO2016066879A1 (fr) 2014-10-30 2015-10-29 Dispositif de localisation d'arrythmies cardiaques

Country Status (4)

Country Link
US (1) US11672463B2 (fr)
EP (1) EP3213680B1 (fr)
ES (2) ES2572142B1 (fr)
WO (1) WO2016066879A1 (fr)

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US20180132741A1 (en) 2018-05-17
ES2572142A2 (es) 2016-05-30
EP3213680B1 (fr) 2023-09-06
EP3213680C0 (fr) 2023-09-06
EP3213680A4 (fr) 2018-06-27
EP3213680A1 (fr) 2017-09-06
US11672463B2 (en) 2023-06-13
ES2572142B1 (es) 2017-06-21

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